- Each proposed code arrives with the supporting documentation and the governing rule attached, so the coder starts from an assessed chart instead of a blank one.
- Risk adjustment review looks both ways: documented conditions that were never coded, and codes the documentation does not support.
- A certified coder still signs every code. H2O makes no clinical efficacy claim and changes where the coder starts, not who decides.
- An optional model can rank the coding worklist, so the charts most likely to need a change are reviewed first.
Every chart is read line by line, against rules that live somewhere else
The rule that decides whether a code is supported lives in coding guidelines and payer policy, not in the chart. Your coders read notes, problem lists, and results, then check each code against rules that vary by payer.
Under-code and you are not paid for care you delivered. Over-code and you have a compliance problem instead. Meanwhile, charts wait to be coded and billed.
How medical coding and risk adjustment review works
Enterprise h2oGPTe reads the documentation, retrieves the governing rules, and writes each proposal with a citation.
Step 1: bring in the documentation
Progress notes, discharge summaries, problem lists, and results come from the systems you connect. Scanned outside records are read by Document AI.
Step 2: check it against the rules
The documentation is compared with the coding guidelines and payer policies you keep in a collection. Each retrieved rule carries a reference to its source.
Step 3: propose and flag
The review returns proposed codes, codes that lack support, and conditions that are documented but not coded, each with the evidence and the rule cited.
Step 4: rank the worklist
An optional model built in H2O Driverless AI scores charts on the chance a code change is needed, with reason codes.
Step 5: review and sign
Your certified coder accepts, edits, or rejects each proposal and signs. Unclear documentation goes to the physician as a query through your existing process.
Step 6: keep the record
Every proposal and every coder decision is logged, so your compliance and audit teams can see what was suggested and what was signed.
Risk adjustment and HCC coding
Risk adjustment depends on Hierarchical Condition Category (HCC) codes that the documentation supports. The review lists each chronic condition it finds in the record, the HCC it maps to, and the note that supports it. It also flags HCC codes on a claim whose support it cannot find in the chart. Your coder decides on both, and your documentation team decides whether a provider query is needed.
Who decides
H2O makes no clinical efficacy claim. The system prioritizes a worklist and proposes a code with the governing rule cited, and your certified coder still signs. It changes where the coder starts, not who decides.